Posterior fat pad dogma bust

Short Attention Span Summary

Not so fast with the pedi-dogma bust
A posterior fat pad on x-ray equals splint for either occult supracondylar humerus in kids or occult radial head in adults, right? This study found that 111 patients with isolated posterior elbow fat pad on x-ray did well, recovered, and didn't need surgery.  Problem is, the median age was 15, with an interquartile range of 9-27 years.  So this study doesn't apply to younger kids.

Spoon Feed
Adults with isolated posterior fat pad on x-ray do great.  Give them a sling for comfort.  This study sheds no light on this injury in kids.  Splint kids with a posterior fat pad on x-ray, because it's not the radial head - it's the supracondylar humerus.  And that's not funny.

Many thanks to First10EM.  I found this article on his outstanding blog.

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Abstract

Isolated fat pad sign in acute elbow injury: is it clinically relevant?
Eur J Emerg Med. 2016 Jun;23(3):228-31. doi: 10.1097/MEJ.0000000000000288.

Isolated fat pad sign in acute elbow injury: is it clinically relevant?

Jie KE1, van Dam LFHammacher ER.

Author information:

1aDepartment of Emergency Medicine, Jeroen Bosch Ziekenhuis, Den Bosch bDepartment of Emergency Medicine, Ziekenhuis Rivierenland, Tiel cDepartment of Emergency Medicine, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.

Abstract

An isolated fat pad sign (i.e. joint effusion without a visible fracture), commonly seen in acute elbow injury, is associated with occult fracture and treated as such. However, the clinical relevance of an isolated fat pad is unclear, thereby questioning the need for specialized follow-up. In this study, 111 patients (median age 15 years, interquartile range 9-27 years) with an isolated fat pad sign after acute elbow injury were included. The clinical relevance of an isolated fat pad sign was derived from descriptives on pain, elbow function, treatment change, number of revisits and recovery time after 1 week follow-up and long-term follow-up. Treatment alterations were rarely made and none of the patients needed an operative intervention; also, none of the patients had persistent symptoms. The median recovery time was 3 weeks (interquartile range 2-12 weeks). This study shows that, unless symptoms persist or worsen, regular follow-up at a specialized outpatient clinic is not needed.

PMID: 26153882 [PubMed - in process]